Pouch Satiety After Bariatric Surgery

6 Steps to Keep Pouch Satiety After Bariatric Surgery

March 21, 2018

Weight loss surgery (also known as bariatric surgery) is an excellent tool. The surgery can help reduce the overall volume of food consumed through the restrictive nature of reducing the size of the stomach pouch and the impact surgery has on altering appetite regulating gut hormones.

The reduced sized stomach pouch promotes a sense of fullness after consuming a reduced portioned meal or snack. This sense of fullness is a benefit for a patient to feel compared to the lack of fullness an individual may experience when attempting to reduce caloric intake and portion sizes at mealtime without this helpful surgical tool.

The alteration in gut hormones is also helpful in promoting appetite control immediately following an eating occasion and between eating occasions (6). To keep pouch satiety after bariatric surgery is important for patients.

While bariatric surgery is an effective tool, many individuals do report increased hunger and cravings over time following this surgical procedure. Strategies to manage hunger and achieve a sense of satiety remain a very common discussion and an area of interest for patients in post-op clinic visits.

The topic of satiety is a perfect example of how bariatric surgery is simply a tool.  While this surgical tool helps an individual better manage appetite and promotes satiety, it is not the only factor at play. There are numerous other factors that influence satiety and perception of satiety. Therefore, it is important to consider these other influential factors and focus attention in these areas in combination with the tool of surgery to improve satiety long term.

6 Steps to Keep Pouch Satiety After Bariatric Surgery

Protein and Fiber:  The nutritional composition of meals chosen during advanced meal planning or in the moment decision making (ie. at a dinner party or restaurant) plays a role in satiety. Research supports the satiating effects of protein, fiber, and certain types of fat in the diet (2,5,9).  Aiming to achieve adequate daily protein intake from a variety of protein-rich food sources (ie. fish/seafood, poultry, eggs, beans, lentils, tofu, Greek yogurt, cottage cheese, seitan, etc.), and optimizing fiber intake from fiber sources (ie. fruit, vegetables, nuts, seeds, beans, lentils, peas, oats, etc.) are behavioral modification strategies to promote satiety.

Regular post-op follow-up with a dietitian is beneficial to continually assess changes in macronutrient needs and to provide guidance in establishing daily protein and fiber goals.

Use of a food tracking tool has been supported through research to be an effective strategy to help individuals manage their weight long-term (8). Additionally, a food tracking tool can be used to monitor protein and fiber intake and identify opportunity for improvement in these areas to promote satiety.

While certain fats have been shown to improve satiety after consumption, adding additional fat into the diet with the goal of achieving satiety should be used with caution (and in nutritional practice, I only recommend it when appropriate for individual cases; never as a broad recommendation for all).

It is important to note that fat provides the greatest calorie content per gram (9 calories per gram) compared to calories provided by protein and fiber (each has 4 calories per gram).  Therefore, the satiating effects of fat come with significantly higher caloric content.  For best weight loss results, optimize protein and fiber intake first.

Action Step:  Track protein and fiber intake, and optimize to meet daily goals. 

Eat Solid Food Choices:  Focus on consuming more whole, solid foods at mealtime in place of liquid meals (ie. shakes, smoothies, soups, etc.) to improve the likelihood of achieving satiety (1, 4).

Simply stated, liquid meals travel through the digestive tract much faster and empty out of the stomach pouch sooner compared to solid meals. The longer the food is in the stomach pouch as part of the digestion process, the longer an individual may feel a sense of satiety.

If an individual is relying on liquid protein supplements or soups for multiple eating occasions and is experiencing an increase in hunger between meals, incorporating more solid, whole food containing meals in place of liquid meals can improve the likelihood of feeling satiety. Take the time to plate a solid meal, savor each bite, chew thoroughly, and observe any changes in appetite control between meals.

Action Step: Consume foods whole and in solid form to achieve and extend satiety. 

Stay Hydrated:  Hydration status plays a role in satiety. Drinking water and other fluids (ideally, non-caloric beverages for best weight management outcomes) between meals fill the stomach pouch temporarily creating a sense of fullness.

As an individual strives to achieve a certain fluid goal or level of hydration each day this may positively result in a feeling of satiety between meals. Individuals who consume an appropriate amount of water or hydrating beverages between meals will have less of an opportunity to feel increases in hunger between meals and this may indirectly have a positive impact on delaying, reducing, or preventing frequent snacking or grazing behavior. (I encourage a minimum of 64 fl. oz. per day for the average healthy adult.)

Action Step:  Set goal to drink more between meals.

Get Sleep:  Sleep plays a role in satiety. Research indicates that a lack of sleep or sleep deprivation may alter gut hormones promoting increased hunger and a reduced feeling of satiety (7).

Additionally, research findings from the National Weight Control Registry indicate that individuals who have successfully maintained weight loss long term are more likely to report greater than 6 or 7 hours of sleep per night (10).

Thus prioritizing sleep is a key consideration in not only achieving satiety but also in managing weight long term.  Establishing a bedtime and eliminating distractions in the bedroom (ie. technology) can be a few first steps to improving the duration of sleep.

Action Step: Prioritize adequate sleep.   

Mindful of Food:  There is a cognitive component to achieving satiety; meaning the way we think about food impacts our satiety.

Studies have demonstrated that an individual’s expectations of satiety of a particular food or meal prior to eating can actually have an impact on appetite-regulating gut hormones following the meal (2, 3).

For example, an individual’s perception that a meal will be filling may actually play a role in altering gut hormones. This can result in improved satiety post-meal compared to the lack of satiety an individual may report following a meal that was initially perceived as less substantial or reduced calorie.

As a dietitian, I apply this information in practice, by encouraging patients to think about food in a positive and functional light.  Specifically being mindful of the satiating aspects of different foods can positively improve the likelihood of feeling satiety after eating such foods.

Action Step: Be mindful of the satiating aspect of food when approaching a meal.    

Address Stress:  There are non-physiological factors that drive the desire to eat. Factors such as environmental cues or triggers (ie. sweets brought into the home or break room at work) or a less productive stress coping mechanism (ie. eating as a response to a stressful workday) can influence an individual’s feeling of hunger and ability to achieve satiety.

Addressing these factors through problem-solving on how to better manage one’s environment (ie. keeping sweets out of the home and avoiding the work break room). Learn how to cope with stress in a non-food related way (ie. talking to a friend, exercise, meditation, deep breathing as a few examples). Also, seek guidance and support from a health psychologist to create strategies to help tame hunger and cravings and may lead to a sense of improved satiety.

Action Step: Address stress coping and environmental cues that may be driving hunger or cravings. 

References

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  1. Chambers, L., McCrickerd, K., & Yeomans, M. R. (2015). Optimising foods for satiety. Trends in Food Science & Technology, 41(2), 149-160.
  1. Crum, A. J., Corbin, W. R., Brownell, K. D., & Salovey, P. (2011). Mind over milkshakes: mindsets, not just nutrients, determine ghrelin response. Health Psychology30(4), 424.
  1. Jones, L. V., Jones, K. M., Hensman, C., Bertuch, R., McGee, T. L., & Dixon, J. B. (2013). Solid Versus Liquid—Satiety Study in Well-Adjusted Lap-Band Patients. Obesity Surgery, 23(8),
  1. Leidy, H. J., Clifton, P. M., Astrup, A., Wycherley, T. P., Westerterp Plantenga, M. S., Luscombe-Marsh, N. D., … Mattes, R. D. (2015). The role of protein in weight loss and maintenance. American Journal of Clinical Nutrition, 101(6), 1320S-1329S.
  1. Meek, C. L., Lewis, H. B., Reimann, F., Gribble, F. M., & Park, A. J. (2016). The effect of bariatric surgery on gastrointestinal and pancreatic peptide hormones. Peptides, 77, 28-37.
  1. Morselli, L., Leproult, R., Balbo, M., & Spiegel, K. (2010). Role of sleep duration in the regulation of glucose metabolism and appetite. Best Practice & Research Clinical Endocrinology & Metabolism, 24(5), 687-702.
  1. Odom, J., Zalesin, K. C., Washington, T. L., Miller, W. W., Hakmeh, B., Zaremba, D. L., McCullough, P. A. (2009). Behavioral Predictors of Weight Regain after Bariatric Surgery. Obesity Surgery, 20(3), 349-356.
  1. Poppitt, S. D. (2017). Obesity and Weight Control: Is There Light at the End of the Tunnel? Current Nutrition Reports, 6(2), 51-62.
  1. Ross, K. M., Graham Thomas, J., & Wing, R. R. (2015). Successful weight loss maintenance associated with morning chronotype and better sleep quality. Journal of Behavioral Medicine, 39(3), 465-471.

ABOUT THE AUTHOR

Ashley Barrient, MEd, LPC, RD, LDN earned her Bachelor of Science in Nutrition and Dietetics from the University of Southern Mississippi and completed her graduate level Dietetic Internship Program through Loyola University Chicago. Ashley has practiced as a Registered, Licensed Dietitian in the Chicago area since 2009 and has held her Licensure as a Professional Counselor in the state of Illinois since 2011. Ashley works collaboratively with other practitioners within Northwestern Medical Faculty Foundation to provide patients with a multidisciplinary approach to obesity treatment and management.